Felice J. Freyer: Tall ambitions for Obamacare in R.I. - more than insurance

Sunday

Sep 1, 2013 at 12:00 AM

Christy Ferguson has big plans for Rhode Island. But although she talks about them all the time, you rarely hear about it.

By Felice J. Freyer

Christy Ferguson has big plans for Rhode Island.

But although she talks about them all the time, you rarely hear about it.

That’s probably because Ferguson is working on one of the most complex government efforts in history: She is director of HealthSource RI, the Obamacare marketplace where tens of thousands of Rhode Islanders will buy next year’s health-insurance plans.

Merely explaining the nuts and bolts of what this is and how it will work is taking up everyone’s time.

If you listen to Ferguson, though, you’ll realize that her vision goes way beyond just helping people get health insurance. Before I bury my head in the next set of spreadsheets, I’m clearing a little space to describe — not endorse, not critique, just describe — her tall ambitions for HealthSource RI.

For starters, HealthSource RI is intended to be a classroom. “What we’re doing is really shining the light on how insurance works and how we can change it collectively as well as individually through our choices,” Ferguson said at an Aug. 20 briefing. Rhode Island is one the few states allowing “full employee choice,” meaning that small businesses can contribute a certain amount toward their employees’ health insurance but let the employees select from any plan on the exchange.

In making those choices, people will have to think about how they use health care and what tradeoffs work best for them. Do they want to have the lowest possible premiums — and risk having to pay a lot out of pocket if they need health care? Are they willing to shop for the best price to lower their out-of-pocket costs? Do they like the providers in the plan’s preferred network?

HealthSource RI intends to push insurers to develop more plans that emphasize preventive care, maintaining health and keeping people out of the hospital. Eventually, Ferguson says, the exchange will track not just whether a health plan offers good service but how its members fare overall: Are they getting good care? Which provider networks are getting the best results?

“Over the course of the next two years we’re going to be working with providers to make some of that transparent,” Ferguson says.

Think of the potential — essentially consumers would be able to see which health-insurance plans are more likely to make them healthy. This could transform the way care is delivered.

Ferguson hopes that the exchange will make buying insurance so easy and predictable that small employers will flock to it. But more than that, Ferguson wants to demonstrate the business value of offering health insurance — by showing that employees with access to health care make better workers. “We are developing a mechanism to start to measure some of that stuff,” she said.

And then, possibly the biggest dream of all: HealthSource RI could be a boost to the state’s economy, by making it more attractive to business.

“If this is done properly,” Ferguson says, “the predictability of the pricing, the quality of the health care that we provide in our state and our ability to be transparent about what that quality is, the ability to use the exchange as a small business or startup — we could use this as a mechanism to support economic development.”

Ferguson knows she’s reaching high. “We have a lot of work to do over the next couple of years,” she says. “There’s no sure bet. This has never been done before. Never, ever.”

As HealthSource RI starts enrollment on Oct. 1, observers will have lots of questions: Will the computer system be ready on time and work properly? Will the contact center provide good service? Will enough young people sign up? Will businesses continue to buy insurance, or drop coverage and dump their employees on the exchange?

All good questions for the short term. But as the years go by, let’s not forget how high Ferguson has set the bar, and also ask the big questions: Since HealthSource RI started, is health care more rational and more reasonably priced? Are people healthier? Are small businesses thriving? Is Rhode Island a better place to live?

Every other Sunday, Health Insight offers analysis, viewpoints and conversations to help you make sense of health care and medicine. Questions and suggestions are welcome. The next Health Insight column will appear Sept. 15.

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